Travel Fears: Africa – Disease, HIV and Light Hypochondria

Luapula Province, Zambia

I began this series of posts with a piece exploring the topic of race.  In this, the 2nd in the series, I will continue to share the concerns, uncertainties and revelations that led up to and culminated in my visit to Zambia.  I do this in the hope of helping many of you better understand  your own fears, paranoia  and to perhaps answer questions you might otherwise be uncomfortable asking or discussing.  The topics in this series are delicate ones, many of which are considered off-limits or too embarrassing to discuss openly.  As I seek to express, analyze and discuss them, please keep this in mind.   A more in-depth introduction can be found in the first post in this series: Travel Fears: Africa – Revelations as A White Traveler.

I don’t write about romance on the road much because…well…contrary to the stereotypes about hostel, backpacking, and study abroad life it’s not something I pursue actively while traveling and/or when it does occur, it’s not something I feel inclined to write about. One factor that shapes my more reserved approach to travel romance is what, for the sake of this post, I’ll call low-level hypochondria. This is a bit of a disservice to true hypochondriacs and their personal challenges as I’m not truly a hypochondriac but  better conveys the nature of some of the unfounded fears addressed in this post.  I have an overly developed fear/paranoia when it comes to STDs (sexually transmitted diseases) and TDs (transmitted diseases).  To the point that, despite being very empirical by nature and knowing the effectiveness rate of things like condoms they still do very little to alleviate my fears.  Fears which can be strong enough to alter my behavior or prevent me from enjoying opportunities.  For example,  I know how safe condoms and common sense are, but at the end of the day that knowledge is insufficient peace of mind and protection to allow me to pursue passing travel romances as opportunities arise.  From chlamydia to herpes to HIV/AIDs I have a deep seated fear, not just of exposure through sex, but of any form of exposure what-so-ever even if the risk is .0001%.  Add to that the TDs such as Cholera, Typhoid, Dysentery etc. and, well, there was a lot to worry about.

So, I – perhaps like many of you – was unsure what to make of Africa. In Europe and the US the media tends to focus on three topics when discussing sub-Saharan Africa.   Starvation, war, and HIV/AIDs. In Zambia, where multiple concurrent partners are a regular occurrence even among couples and a mixture of doctrine, urban myths, and lack of education are huge issues, HIV/AIDs infection levels are a massive concern. As I prepared for my three week trip, you can imagine some of the thoughts racing through my head … I was, about to go into the heart of the HIV/AIDS epidemic where the average life expectancy at birth is a mere 52 years up from ~38 a few years ago (vs 78 in the US) and the HIV infection rate in 2009 was 14%.  Down from 21% in 2001 and ranking it as the country with the 6th highest level of HIV/AIDs infection in the world. Every day more than 200 people are infected in Zambia alone.  Keeping in mind that these are the statistics for HIV/AIDs and not other STDs should highlight that there was absolutely zero-chance of me partaking in any, and I do mean any, type of romantic encounter during my visit. But, that didn’t mean I wasn’t extremely nervous about the HIV/AIDs issue when planning my trip – after all, you can catch certain types of STDs and TDs (HIV included) without sexual contact, right? Which brings me to the central focus of this post.

In the US where perhaps 1 in 300 people is HIV positive there’s not a lot of exposure to HIV or information.  HIV positive folks don’t advertise their illness, are well medicated, and generally invisible, productive, normal members of the population. A big difference from Zambia where even young children are dying of HIV/AIDs on a regular basis.  In the states there are HIV awareness campaigns and I’ve read numerous articles discussing the nearly non-existent risk of infection through casual social contact.  I know that HIV/AIDs cannot be spread outside of the exchange of sexual fluids, breast milk, or blood being passed between both bodies through fresh/bleeding cuts.  So, as I prepared to take my trip I knew at an intellectual level that short of a sexual encounter or blood transfusion I had absolutely nothing to fear. I planned to avoid any type of sexual contact and had no plans of ending up needing a blood transfusion. I had nothing to worry about.  Yet, at an emotional and irrational level I was still worried.  Knowing that 1 in 7 people was HIV positive … how would I react when expected to shake hands, share silverware, cook together or interact with young children with their myriad of scrapes and cuts knowing that many were likely HIV positive.

Zambian Children - Luapula

These fears are hard to quantify because they’re not the result of general ignorance.  I know that my level of risk from commonly shared surfaces, utensils, food, and social contact is effectively non-existent.  I also have read extensively in school and elsewhere about how brutal and isolating the impact of these types of unfounded fears are on people with diseases like HIV.  So, let me say it again.  I know and knew that these fears were bullshit … but that didn’t matter. It did little to overpower and abolish the mental image of having to shake a construction or farm worker’s cut, callused, and scabbed hand while unsure if they were HIV positive.  Or the thought of an HIV-infected child with the bloody cuts, scabs and snot covered cheeks that go with childhood reaching out and wanting to engage in the simple dignities of human touch. How would I respond?  Would I shun them?  Would I hold myself apart?  Would I embrace them?  Or when the time came, was this all mental gymnastics and would everything be the same?

So, as the wheels of our aircraft touched down at Lusaka International airport I felt a small knot in my stomach.  This was the moment I had been dreading.  Where I would come face to face with my uncertainty.  I shouldn’t have worried.  As I reflect on my behavior during my three-week visit, I know that I was slightly more controlled and reserved than I would have been in the US.  But only slightly.  When I washed my hands, it was out of general hygienic concerns, not out of a fear of HIV, STDs or TD infection.  I shook hands, interacted with kids, hugged the amazing people I met, ate nshima prepared lovingly by local’s hands, and interacted with the Zambians I met with the sincerity and dignity they deserve.  There were moments where I would catch myself hesitating, but these moments were slight and few and far between.  Oh, and yes – many of these individuals were HIV positive.

If, like me, you find yourself preparing for a trip to Africa and worrying over the HIV/AIDs and disease issue I hope this post A) lets you know that you’re not alone  B) that there’s nothing to truly worry about and C) that once on the ground it shouldn’t negatively impact your experience or be an issue.